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Objectives: Metabolic syndrome (MS) is a significant health concern in the working-age population. Since 2008, Japan has mandated health insurers to implement Specific Health Checkups to identify individuals with MS and preliminary groups, making Specific Health Guidance (SHG) compulsory for these groups. People receiving SHG multiple times is increasing as it is conducted as an annual public program. Therefore, we evaluated the influence of a health guidance history on the effectiveness of subsequent guidance. Methods: Using data from 10,191 participants in the 2017 Motivational Health Guidance (a type of SHG involving a single session), this longitudinal study assessed the changes in health checkup findings from 2017 to 2018. Participants were categorized based on their previous year’s (2016) SHG eligibility and participation: Group 1 (n=3,903) met the 2016 SHG criteria and participated, Group 2 (n=2,305) met the criteria but did not participate, and Group 3 (n=3,983) had no MS risk factors and did not need to participate in the 2016 SHG. Results: The entire cohort and Groups 2 and 3 exhibited significant weight loss after 1 year. Group 1 showed a significant negative association, with a 3% (odds ratio [OR] 0.64; 95% confidence interval [CI], 0.55–0.75) and 5% body weight loss (OR 0.66; 95% CI, 0.54–0.81) than Group 3. Men in Group 1 showed a significant association with new-onset MS (OR 2.56; 95% CI, 1.93–3.40). Conclusions: The findings suggest that participants with a history of health guidance in the previous year may have low rates of achieving weight loss and a high incidence of new-onset MS after 1 year.

Background Supporting smoking cessation at pharmacies can be challenging owing to difficulties in recruiting smokers to participate in cessation programs, insufficient communication skills among pharmacists, and lack of knowledge and self-efficacy in successfully quitting smoking in Japan. Objective This study evaluates the effectiveness of a smoking cessation training program on community pharmacists’ knowledge, attitude, and self-efficacy in supporting smoking cessation. Methods The study, conducted in Japanese pharmacies with 100 community pharmacists, employed a quasi-experimental design. Two online training programs were implemented. Participants completed a web-based survey assessing their knowledge, attitude, and self-efficacy in supporting smoking cessation before, immediately after, and 1 year after the training program. A two-way analysis of variance with a mixed model was used to examine score changes at each time point. Results Total knowledge scores significantly increased between baseline and immediately after training and baseline and 1 year after training. The total attitude scores between baseline and immediately after training differed significantly. However, no differences were noted between baseline and 1 year after training. Total self-efficacy scores significantly increased at baseline, immediately after training, and between baseline and 1 year after training. Despite no significant interactions between the programs, there was a partial interaction effect on knowledge, with only the customized program having items whose knowledge levels improved after 1 year. Conclusion and Relevance The training program improved community pharmacists’ knowledge, attitude, and self-efficacy regarding smoking cessation support. The customized program must be reinforced to improve support performance and maintain attitude.

Abstract Background Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. Methods This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. Results The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13–5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22–0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37–0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. Conclusion We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. Trial registration University hospital Medical Information Network (UMIN) Center: UMIN000039475). Approval date 13 February 2020.

ABSTRACT Aims/Introduction The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c − predicted HbA1c derived from the continuous glucose monitoring [CGM]). Materials and Methods We conducted a cross‐sectional study of adults with type 1 diabetes (n = 211, age 50.9 ± 15.2 years old, female sex = 59.2%, duration of CGM use = 2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. Results The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 = 0.44). Conclusions This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.

Abstract Background Living arrangements have been known to be associated with physical frailty. However, the prevalence of frailty and its risk factors in remote islands is not understood. We examined the association between living arrangements and objectively measured frailty among older adults living in a remote island of Japan. Methods Among older people living in Okinoshima, 656 older adults (75.6 ± 6.4 years) were analyzed. Physical frailty (robust, prefrailty, or frailty) was assessed using the 5‐item frailty phenotype (unintentional weight loss, self‐reported exhaustion, weakness, slow walking speed, and low physical activity). Physical functions (muscle mass, gait speed, and grip strength) were measured objectively. Results The prevalence of frailty and prefrailty was 6.6% and 43.8%, respectively. Living with a spouse resulted in a significantly lower prevalence of frailty (p

Abstract Background In women, slender body habitus has been reported to be one of the predisposing factors underlying the development and poor prognosis of non-tuberculous mycobacterial lung disease (NTM-LD). Given the lack of nutritional data contributing to treatment strategies, we aimed to clarify the nutritional status of female patients with NTM-LD and its association with disease severity. Methods In this single-center observational study, we enrolled 81 female outpatients with NTM-LD. Data on healthy women of similar ages were selected from our previous survey data and categorized as controls. First, we compared anthropometric and dietary survey data between patients and controls. Second, after the patients were categorized into relatively mild (mild, n = 40) and relatively severe groups (severe, n = 41) based on pulmonary X-ray-image finding scores, body composition, nutritional intake, and biochemical markers were compared between the groups. To identify nutritional factors associated with disease severity, logistic regression analyses were performed. Results Compared with controls, patients with NTM-LD had significantly lower energy intake, body mass index, body fat, and skeletal muscle mass (all p

Abstract Background The major complication of renal biopsy is bleeding. Infection is an extremely rare complication of percutaneous renal biopsy, providing sterile techniques are used and bowel perforation does not occur. However, the questionnaire included in the Kidney Biopsy Guidebook 2020 in Japan reported that antibiotic prophylaxis was administered to patients undergoing percutaneous renal biopsy at 61% of 170 adult institutions and 57% of 54 pediatric institutions. The objective of this study is to show the non-inferiority of not administering antibiotic prophylaxis for percutaneous renal biopsy. Methods Patients aged ≥15 years who are scheduled to undergo percutaneous renal biopsy are eligible for inclusion in the study. Three hundred and sixty-four patients will be recruited at 6 hospitals. The patients will be randomly assigned at a 1:1 ratio to receive either a single dose of intravenous cefazolin (1 g) or no antibiotic prophylaxis. The primary outcome is the number of patients that exhibit positive urine cultures (>105 colony-forming units/ml) 3 or 4 days after the renal biopsy, or at which point the patients are diagnosed with pyelonephritis until 3 or 4 days after the renal biopsy. The secondary outcomes are the number of patients who are diagnosed with pyelonephritis within 30 days after the renal biopsy, the number of patients who are diagnosed with puncture site infections within 30 days after the renal biopsy, the number of patients who are diagnosed with an infection other than pyelonephritis or a puncture site infection within 30 days after the renal biopsy, and the number of patients who experience cefazolin-induced side effects. Discussion This randomized controlled trial aims to show the non-inferiority of not administering antibiotic prophylaxis for percutaneous renal biopsy. If this study shows that antibiotic prophylaxis is not needed, it would help to ensure patient safety and prevent the development of antibiotic-resistant bacteria. Trial registration UMIN Clinical Trials Registry (UMIN-CTR) UMIN000042378 . Registered on 7 Nov 2020.

BackgroundCommercial smartphone apps that promote self-monitoring of weight loss are widely available. The development of disease-specific apps has begun, but there is no app for specific health guidance (SHG) to prevent metabolic syndrome, type 2 diabetes, and cardiovascular diseases in middle-aged adults in Japan. ObjectiveThis study aimed to determine the efficacy of an SHG mobile health app in facilitating weight loss in Japanese adults with obesity and hypertension. MethodsIn a 12-week, statistician-blinded, randomized parallel controlled trial, 78 overweight and obese men aged 40-69 years were assigned in a 1:1 ratio to either the usual support plus KENPO-app group (intervention group) or the active control group. KENPO-app (release April 10, 2019; OMRON Healthcare Co., Ltd.) was developed by the study team and focus groups and uses behavior change techniques (ie, self-monitoring and goal-setting theory). This app was developed for SHG based on the four specific health checkups and guidance system in Japan: (1) focusing primarily on achieving the target (weight loss of ≥2 kg); (2) assessing healthy eating, exercise habits, smoking habits, relaxation, and self-weighing; (3) providing information on the results of specific health checkups; and (4) starting an intervention period of 6 months with the interim assessment at 3 months. The initial assessment explored the following: personality traits (4 types), health checkup data concerns (10 items), symptom concerns (10 items), and the aim of the intervention (weight loss, improving fitness, symptoms, laboratory data). Chatbot-supported health information on health and health behavior was selected from 392 quizzes based on app data and was provided to participants. The KENPO-app had chatbot-supported feedback and information provision combined with a self-monitoring tool (weight, steps, and blood pressure). Data on active exercise, healthy eating, and healthy lifestyle habits were obtained using a web-based self-administered questionnaire at baseline and 12 weeks. ResultsThe trial’s retention rate was 95% (74/78). The adherence to daily self-weighing, wearing the pedometer, and blood pressure monitoring in the KENPO-app group was significantly higher than those in the active control group. Compared with the active control group, the median body weight and BMI of the intervention group significantly decreased at 3 months (–0.4, IQR –2.0 to 0.6 kg vs –1.1, IQR –2.7 to –0.5 kg; P=.03; –0.1, IQR –0.6 to 0.3 kg vs –0.4, IQR –0.8 to –0.2 kg; P=.02, respectively). The intervention increased the percentage of participants who self-reported taking ≥8000 steps, eating vegetables before rice, eating slowly, and relaxing. Personality traits were associated with the degree of weight loss in the intervention group. ConclusionsThe SHG-specific KENPO-app was feasible and induced modest but significant weight loss in adults with obesity. Trial RegistrationUniversity Hospital Medical Information Network Center UMIN000046263; https://tinyurl.com/bderys3b

Lifestyle interventions have been shown to prevent or delay the onset of diabetes; however, inter-individual variability in responses to such interventions makes lifestyle recommendations challenging. We analyzed the Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1) study data using a previously published mechanistic simulation model of type 2 diabetes onset and progression to understand the causes of inter-individual variability and to optimize dietary intervention strategies at an individual level. J-DOIT1, a large-scale lifestyle intervention study, involved 2607 subjects with a 4.2-year median follow-up period. We selected 112 individuals from the J-DOIT1 study and calibrated the mechanistic model to each participant's body weight and HbA1c time courses. We evaluated the relationship of physiological (e.g., insulin sensitivity) and lifestyle (e.g., dietary intake) parameters with variability in outcome. Finally, we used simulation analyses to predict individually optimized diets for weight reduction. The model predicted individual body weight and HbA1c time courses with a mean (±SD) prediction error of 1.0 kg (±1.2) and 0.14% (±0.18), respectively. Individuals with the most and least improved biomarkers showed no significant differences in model-estimated energy balance. A wide range of weight changes was observed for similar model-estimated caloric changes, indicating that caloric balance alone may not be a good predictor of body weight. The model suggests that a set of optimal diets exists to achieve a defined weight reduction, and this set of diets is unique to each individual. Our diabetes model can simulate changes in body weight and glycemic control as a result of lifestyle interventions. Moreover, this model could help dieticians and physicians to optimize personalized nutritional strategies according to their patients' goals.

BackgroundWe have previously reported that female patients with nontuberculous mycobacterial lung disease (NTM-LD) are thinner and eat less than healthy controls. Therefore, we hypothesized that their thinness is associated with body size misperception. The aim of this study was to clarify whether patients' body size perception (BSP) is associated with body mass index (BMI) independent of potential confounders.MethodsIn this cross-sectional study, we assessed 81 outpatients for BSP using the Japanese version of Body Image Scale, body composition, dietary intake, and biochemical markers. As a control, we used BSP and self-reported anthropometric data from 111 healthy women collected via a web survey. First, BSP and BMI were compared between the patients and the controls. Second, patient data was compared between patients who overestimated their body size (OE, n = 31) and a control who did not (Non-OE, n = 50). Multiple regression analysis was performed to clarify the association between BSP (independent variable) and BMI (dependent variable), adjusting for potential confounders, such as age, disease duration, and nutritional factors.ResultsThere was a negative correlation between body size distortion and BMI in both patients and controls (p < 0.001, both). In interpatient comparisons, the OE group had significantly lower BMI and body fat percentage (p < 0.001, both), normalized energy (p = 0.037), and protein (p = 0.013) intakes, and significantly greater weight loss from age 20 (p = 0.003) than the Non-OE group. Multiple regression analysis revealed that overestimation of body size was associated with lower BMI independent of confounders, such as longer disease history, longitudinal weight loss, and nutritional factors.ConclusionThese findings suggest that body size distortion is an etiological factor for lower BMI in female patients with NTM-LD. Thus, it may be important to understand the patient's body image when providing dietary advice.

Abstract Aims/Introduction Type 1 diabetes is associated with poorer bone quality. Quantitative ultrasound provides an estimate of bone mineral density (BMD) and can also be used to evaluate bone quality, which is associated with an increased fracture risk in people with type 1 diabetes. The aim of this study was to evaluate the association between menopausal status and a bone turnover marker with heel BMD using quantitative ultrasound in women with type 1 diabetes and age‐ and body mass index‐matched controls. Materials and Methods A total of 124 individuals recruited in Kyoto and Osaka, Japan – 62 women with type 1 diabetes (mean age 47.2 ± 17.3 years) and 62 age‐, menopausal status‐, sex‐ and body mass index‐matched non‐diabetic control individuals (mean age 47.3 ± 16.3 years) – were enrolled in this study. Heel BMD in the calcaneus was evaluated using ultrasonography (AOS‐100NW, Hitachi‐Aloka Medical, Ltd., Tokyo, Japan). A bone turnover marker was also measured. Results The heel BMD Z‐score was significantly lower in premenopausal women with type 1 diabetes than in the premenopausal control group, but not in postmenopausal women with type 1 diabetes. Levels of tartrate‐resistant acid phosphatase‐5b, a bone resorption marker, were significantly higher in premenopausal women with type 1 diabetes than in the premenopausal control group, but not in postmenopausal women with type 1 diabetes. The whole parathyroid hormone level was significantly lower in both pre‐ and postmenopausal women with type 1 diabetes. Conclusions Lower heel BMD, higher tartrate‐resistant acid phosphatase‐5b level and lower parathyroid hormone were observed in premenopausal women with type 1 diabetes. Premenopausal women with type 1 diabetes require osteoporosis precautions for postmenopause.

Abstract Objectives Frequent self-weighing is associated with weight loss and maintenance, but the relationship between frequent self-weighing and the incidence of type 2 diabetes (T2D) remains unclear. The study aim was to examine the association between self-weighing frequency and the incidence of T2D in people with impaired fasting glucose (IFG). Results We tested the hypothesis that self-weighing frequency and the incidence of T2D are associated in 2607 people with IFG (1240 in the intervention arm; 1367 in the self-directed control arm). Both arms received a weighing scale with storage function. Healthcare providers offered a one-year goal-focused lifestyle intervention via phone. Participants were divided into 4 categories based on self-weighing frequency (No data sent [reference group], low:

Abstract Objective Low birth weight (LBW) is a major public health issue as it increases the risk of noncommunicable diseases throughout life. However, the genome-wide DNA methylation patterns of full-term LBW infants (FT-LBWs) are still unclear. This exploratory study aimed to analyze the DNA methylation differences in FT-LBWs compared with those in full-term normal birth weight infants (FT-NBWs) whose mothers were nonsmokers and had no complications. Initially, 702 Japanese women with singleton pregnancies were recruited. Of these, four FT-LBWs and five FT-NBWs were selected as references for DNA methylation analysis, and 862,260 CpGs were assessed using Illumina Infinium MethylationEPIC BeadChip. Gene ontology enrichment analysis was performed using DAVID v6.8 software to identify the biological functions of hyper- and hypomethylated DNA in FT-LBWs. Results 483 hyper-differentially methylated genes (DMGs) and 35 hypo-DMGs were identified in FT-LBW promoter regions. Hyper-DMGs were annotated to 11 biological processes; “macrophage differentiation” (e.g., CASP8), “apoptotic mitochondrial changes” (e.g., BH3), “nucleotide-excision repair” (e.g., HUS1), and “negative regulation of inflammatory response” (e.g., NLRP12 and SHARPIN). EREG was classified into “ovarian cumulus expansion” within the “organism growth and organization” category. Our data imply that LBW might be associated with epigenetic modifications, which regulate the immune system and cell maturation.

Introduction Fibroblast growth factor (FGF) 21 is an important regulator of glycemic control, but the association between circulating FGF21 and diabetic complications is poorly understood. Moreover, basal FGF21 secretion, especially in response to insulin dose, in patients with type 1 diabetes mellitus (T1DM), has not been well examined. Therefore, this study aimed to determine the association of circulating FGF21 levels with diabetic complications and insulin dosage in middle-aged and elderly patients with T1DM. Materials and methods A total of 127 middle-aged and elderly patients with T1DM, including 68 patients with diabetic complications, and 106 non-diabetic individuals were analyzed in this cross-sectional study. Information on demographic characteristics and T1DM was extracted from their electronic medical records. Serum FGF21 levels were determined using ELISA. Results Serum FGF21 levels were significantly lower in T1DM patients (75.2 [37.4–135.1] pg/mL) than in non-diabetic participants (151.6 [92.0–224.6] pg/mL; P < 0.001). No diabetic complications were associated with serum FGF21 concentrations. Both basal and bolus insulin doses were significantly and positively correlated with serum FGF21 levels (P < 0.05). Stepwise multiple regression analysis showed that FGF21 level was associated with age and body mass index (P < 0.05), while the basal insulin dose was an independent positive predictor of serum FGF21 levels (β = 0.197, P = 0.032). Conclusions Circulating FGF21 levels are reduced in patients with T1DM; however, they are not associated with diabetic complications. In addition, aging, obesity, and insulin dosage are positive determinants of circulating FGF21.

Abstract Background Given the major role of glucose-dependent insulinotropic polypeptide (GIP) in the regulation of adiposity, this study examined the effects induced by a diet based on the Japanese tradition (SMART WASHOKU) on the visceral fat area (VFA) and GIP secretions. Methods Overweight/obese men (n = 21; mean age, 41.0 ± 9.0 years; mean BMI, 25.2 ± 2.0 kg/m2) without diabetes were placed on either a SMART WASHOKU or control meal for 2 weeks, in a randomized, cross-over setup with a four-week washout period. Results For the meal tolerance test, blood samples were collected at 0, 30, 60, 120, 180, and 240 min post-meal, followed by measuring blood glucose, insulin, GIP, and glucagon-like peptide-1 (GLP-1) levels. Relative to a control meal, SMART WASHOKU meal yielded significantly lower plasma postprandial GIP concentrations (AUC: 700.0 ± 208.0 vs. 1117.0 ± 351.4 pmol/L・4 h, P

Background: Hepcidin-25 is a 25 amino acid hepatokine and a key regulator of iron metabolism related to iron deficiency anemia. Recent studies have suggested that an elevated hepcidin level is correlated with low energy availability. Leptin is an appetite-suppressing adipokine and has been reported to stimulate hepcidin production in animals and cultured cells. While leptin is modulated by exercise, it is known that endurance runners and sprinters practice different types of exercise. This study investigated and compared the relationships between hepcidin and leptin levels, iron status, and body fat to understand better the risk of iron deficiency anemia in endurance runners and sprinters.Methods: Thirty-six male college track and field athletes (15 endurance runners and 21 sprinters) were recruited for this study. Dietary intake, body composition, and blood levels of ferritin, hepcidin-25, leptin, and adiponectin were measured. Correlations between hepcidin levels and ferritin, body fat, leptin, and adiponectin were evaluated using Pearson's correlation coefficient for each group.Results: The endurance runners had lower hepcidin levels and higher leptin and adiponectin levels compared with sprinters. Ferritin was positively correlated with hepcidin-25 levels in both the endurance and sprinter groups. A positive correlation was observed between hepcidin-25 and body fat or leptin levels only in sprinters.Conclusion: This is the first study investigating the relationship between blood levels of hepcidin and leptin in athletes. The positive correlation between hepcidin-25 and leptin was observed in sprinters but not endurance runners.

Brown adipose tissue (BAT) mediates adaptive thermogenesis upon food intake and cold exposure, thus potentially contributing to the prevention of lifestyle-related diseases. 18F-fluorodeoxyglucose (FDG)–positron emission tomography (PET) with computed tomography (CT) (18FDG–PET/CT) is a standard method for assessing BAT activity and volume in humans. 18FDG–PET/CT has several limitations, including high device cost and ionizing radiation and acute cold exposure necessary to maximally stimulate BAT activity. In contrast, near-infrared spectroscopy (NIRS) has been used for measuring changes in O2-dependent light absorption in the tissue in a non-invasive manner, without using radiation. Among NIRS, time-resolved NIRS (NIRTRS) can quantify the concentrations of oxygenated and deoxygenated hemoglobin ([oxy-Hb] and [deoxy-Hb], respectively) by emitting ultrashort (100 ps) light pulses and counts photons, which are scattered and absorbed in the tissue. The basis for assessing BAT density (BAT-d) using NIRTRS is that the vascular density in the supraclavicular region, as estimated using Hb concentration, is higher in BAT than in white adipose tissue. In contrast, relatively low-cost continuous wavelength NIRS (NIRCWS) is employed for measuring relative changes in oxygenation in tissues. In this review, we provide evidence for the validity of NIRTRS and NIRCWS in estimating human BAT characteristics. The indicators (IndNIRS) examined were [oxy-Hb]sup, [deoxy-Hb]sup, total hemoglobin [total-Hb]sup, Hb O2 saturation (StO2sup), and reduced scattering coefficient (μs sup′) in the supraclavicular region, as determined by NIRTRS, and relative changes in corresponding parameters, as determined by NIRCWS. The evidence comprises the relationships between the IndNIRS investigated and those determined by 18FDG–PET/CT; the correlation between the IndNIRS and cold-induced thermogenesis; the relationship of the IndNIRS to parameters measured by 18FDG–PET/CT, which responded to seasonal temperature fluctuations; the relationship of the IndNIRS and plasma lipid metabolites; the analogy of the IndNIRS to chronological and anthropometric data; and changes in the IndNIRS following thermogenic food supplementation. The [total-Hb]sup and [oxy-Hb]sup determined by NIRTRS, but not parameters determined by NIRCWS, exhibited significant correlations with cold-induced thermogenesis parameters and plasma androgens in men in winter or analogies to 18FDG–PET. We conclude that NIRTRS can provide useful information for assessing BAT-d in a simple, rapid, non-invasive way, although further validation study is still needed.

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.

Abstract Background Brown adipose tissue (BAT) is sympathetically activated and induces thermogenesis during cold exposure, thereby influencing energy expenditure and body fat levels. The very low frequency (VLF) components of pulse rate variability could be a form of thermogenic sympathetic nervous activity, but no clear relationship has yet been reported between VLF activity and BAT density. We therefore aimed to evaluate the association between them. Methods We enrolled 20 adults in winter and 20 matched adults in summer. We assessed BAT densities based on total hemoglobin concentrations ([total-Hb]) measured with near-infrared time-resolved spectroscopy. We calculated VLF activity from pulse rate variability measurements. Results BAT density ([total-Hb]; winter 70.5 ± 17.0 μM, summer 57.8 ± 18.3 μM) and VLF activity (winter 6.7 ± 0.8, summer 6.1 ± 0.9) were significantly higher in winter than in summer (P

Brown adipose tissue (BAT) is responsible for non-shivering thermogenesis and is an attractive therapeutic target for combating obesity and related diseases. Human BAT activity has been evaluated by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) under acute cold exposure, but the method has some serious limitations, including radiation exposure. Infrared thermography (IRT) may be a simple and less-invasive alternative to evaluate BAT activity. In the present study, to establish an optimal condition for IRT, using a thermal imaging camera, skin temperature was measured in the supraclavicular region close to BAT depots (Tscv) and the control chest region (Tc) in 24 young healthy volunteers. Their BAT activity was assessed as the maximal standardized uptake value (SUVmax) by 18FDG-PET/CT. Under a warm condition at 24-27°C, no significant correlation was found between the IRT parameters (Tscv, Tc,, and the difference between Tscv and Tc,, Δtemp) and SUVmax, but 30-120 min after cold exposure at 19°C, Tscv and Δtemp were significantly correlated with SUVmax (r = 0.40-0.48 and r = 0.68-0.76). Δtemp after cold exposure was not affected by mean body temperature, body fatness, and skin blood flow. A lower correlation (r = 0.43) of Δtemp with SUVmax was also obtained when the participant's hands were immersed in water at 18°C for 5 min. Receiver operating characteristic analysis revealed that Δtemp after 30-60 min cold exposure can be used as an index for BAT evaluation with 74% sensitivity, 92% specificity, and 79% diagnostic accuracy. Thus, IRT may be useful as a simple and less-invasive method for evaluating BAT, particularly for large-scale screening and longitudinal repeat studies.

Background and Objectives. The increased prevalence of metabolic syndrome necessitates the establishment of tools for evaluating dietary factors associated with visceral fat accumulation and preventing visceral fat obesity. Here, we aimed to develop a dietary factor assessment tool for evaluating visceral fat accumulation. Methods. We conducted a dietary habit questionnaire survey and visceral fat measurement by bioelectrical impedance analysis in 11,438 adults (Survey 1) and a dietary habit questionnaire survey and dietary assessment based on 3-day meal records in 579 adults (Survey 2). Dietary habit factors were identified by factor analysis with varimax rotation, and their relationship with visceral fat accumulation and major nutrients were analyzed. Results. Factor analysis of the dietary habit questionnaire revealed the following five main dietary factors: “Appetite (15 questions),” “Healthy food choice (5 questions),” “Sedentary behavior (6 questions),” “Calorie restriction (5 questions),” and “Irregular mealtime (4 questions).” “Appetite” correlated positively with visceral fat accumulation and energy intake mainly from carbohydrate. “Healthy food choice” correlated negatively with visceral fat accumulation and positively with the protein/fat ratio, dietary fiber/carbohydrate ratio, and N-3 fatty acid/fat ratio. Dietary guidance to modify excess energy intake and increase nutritional balance might be effective toward preventing visceral fat accumulation. Conclusions. The dietary factor assessment tool developed in this study can be used to diagnose problems related to dietary habits and provide guidance for dietary modifications aimed at preventing visceral fat accumulation.

Physical activity improves various metabolic disturbances. The effect of physical activity on non-alcoholic fatty liver disease (NAFLD) has not been defined, particularly in athletes who are able to consume a diet to increase body mass. The aim of this study was to evaluate the prevalence of NAFLD and associated factors of NAFLD among male university rugby football players [n = 69, 37 forwards (FW) and 32 backs (BK)], relative to age-matched controls (CON; n = 29). For FW players exercise consists of physical contact play, such as ruck, mall, scrum, and tackle. For BK players exercise consists of sprints and endurance running. Liver function tests and bioimpedance analysis to assess body composition were performed. Subjects consuming ≤ 20 g/day of ethanol and exhibiting an aspartate transaminase (AST) level ≥ 33 U/L, and/or alanine transaminase (ALT) level ≥ 43 U/L, were considered to have NAFLD. The PNPLA3 and MTP genotypes were determined using real-time polymerase chain reaction (PCR). The body mass index, body fat mass, and lean body mass were significantly higher in the FW group than in the BK and CON groups (P < 0.05). The total cholesterol, low-density lipoprotein cholesterol, triglyceride, AST, ALT, and alkaline phosphatase levels were significantly higher in the FW group than in the CON group (P < 0.05). The prevalence of NAFLD was significantly higher in the FW group than in the BK group and CON group (18.9, 8.6, and 0.0%, respectively), whereas there were non-significant between-group differences in the frequency of the PNPLA3 and MTP genotypes. These findings indicate that rugby football players, especially those in the FW position, are at higher risk of developing NAFLD, which emphasizes the role of diet and exercise in the development of NAFLD.

The aim of this study was to develop a questionnaire to conveniently assess the diurnal preferences of physical activity (PA) in Japanese university students. A total of 219 subjects completed our novel Morningness-eveningness Exercise Preference Questionnaire (MEEPQ). The MEEPQ consisted of 30 items (15 items for the morning and the same 15 items for the evening) rated on a 5-point Likert scale concerning their preference for participating in PA in the morning and evening. The morning score (MS) and evening score (ES) were determined by summing each of the respective 15 items. The internal consistency and construct validity were assessed, and a factor analysis was conducted. To examine the external validity of the MEEPQ, participants wore an accelerometer for seven consecutive days to measure their PA levels objectively. Finally, the test-retest reliability was evaluated at a one-month interval. The MEEPQ showed excellent internal consistency (Cronbach's alpha = 0.896) and construct validity (morning KMO = 0.913, evening KMO = 0.875). A factor analysis showed a three-factor structure involving Physical Wellness (MEEPQ-W), Psychological Well-Being (MEEPQ-P) and Exercise Barrier (MEEPQ-B). The percent of variance was largest for MEEPQ-W in the morning (45.2%) and MEEPQ-P in the evening (40.8%). Test-retest showed that MEEPQ scores had fair repeatability. Significant and positive associations between scores and objectively measured PA levels were found in the MS and 6-9 AM PA and in the ES and 6-9 PM and 9 PM- 0 AM PA (all p

Objectives: Chronic inflammation and oxidative stress are associated with health and the disease status. The objective of the present study was to investigate the association among white blood cell (WBC) counts, neutrophil counts as a WBC subpopulation, and diacron reactive oxygen metabolites (d-ROMs) levels in an asymptomatic population. Methods: The clinical data, including general cardiovascular risk variables and high-sensitivity C-reactive protein (hs-CRP), were collected from 100 female subjects (mean age, 62 years) in outpatient clinics. The correlation of the d-ROMs with hs-CRP, WBC, and neutrophil counts was examined. Results: The mean/median levels were WBC counts 5.9 × 10 9 /L, neutrophil counts 3.6 × 10 9 /L, hs-CRP 0.06 mg/dL, and d-ROMs 359 CURR U. A simple correlation analysis showed a significant positive correlation of the d-ROMs with the WBC counts, neutrophil counts, or hs-CRP levels. The correlation between d-ROMs and neutrophil counts (β = 0.22, P < 0.05), as well as that between d-ROMs and hs-CRP (β = 0.28, P < 0.01), remained significant and independent in a multiple linear regression analysis adjusted for other variables. A multiple linear regression analysis showed that WBC counts had only a positive correlation tendency to the d-ROMs. Conclusions: Neutrophils may be slightly but more involved in the oxidative stress status, as assessed by d-ROMs, in comparison to the overall WBC. Further studies are needed to clarify the biologic mechanism(s) of the observed relationship.

Objectives: Small dense low-density lipoprotein (sdLDL) which has a small LDL particle size with greater susceptibility to oxidation is regarded as a risk marker for cardiovascular disease. The diacron reactive oxygen metabolites (d-ROMs) test has recently been introduced as an oxidative stress-related marker in the clinic. The aim of the present study was to investigate the correlation between the mean LDL particle size and the oxidative stress status as evaluated by the d-ROMs in dyslipidemic patients. Methods: The study included 278 dyslipidemic patients (121 male and 157 female, mean age, 60 years). Clinical data including the conventional atherosclerotic risk factors in addition to the mean LDL particle size measured with the gel electrophoresis and the d-ROMs were collected. Results: Male patients had a significantly smaller mean LDL particle size than females (262.2 ± 7.5 [SD] vs. 264.3 ± 6.7 Å, P

The merits and demerits of food with health claims for the prevention of metabolic syndrome (MS) are reviewed. One major underlying cause of MS is obesity. Diet and lifestyle changes remain the cornerstones of therapy for obesity, but resulting weight loss is often small and long-term success is extremely uncommon and disappointing. Many anti-obesity drugs have been associated with unintended therapeutic outcomes. Currently, only one drug (mazindol) is approved in Japan for short-term treatment of individuals with a BMI over 35 kg/m2. Treatment with orlistat with dietary modification, caffeine, or protein supplementation; consuming a low-fat diet; adherence to physical activity routines; prolonged contact with participants; problem-solving therapy; and the alternative treatment of acupressure are efficacious in reducing weight regain after weight loss treatment. Because obesity is highly stigmatized, any effective treatment should be made available to improve quality of life and self-image. Therefore, it is necessary to provide information to consumers through the media concerning 1) basic knowledge about health foods and laws concerning them, 2) scientifically based information on safety/effectiveness of health foods and food elements, and 3) reports on health disturbances associated with health foods around the world. Keywords:: metabolic syndrome, obesity, mazindol, orlistat, health food

Clock genes regulate circadian rhythm and are involved in various physiological processes, including digestion. We therefore investigated the association between the CLOCK 3111T/C single nucleotide polymorphism and the Period3 (PER3) variable-number tandem-repeat polymorphism (either 4 or 5 repeats 54 nt in length) with morning gastric motility.Lifestyle questionnaires and anthropometric measurements were performed with 173 female volunteers (mean age, 19.4 years). Gastric motility, evaluated by electrogastrography (EGG), blood pressure, and heart rate levels were measured at 8:30 a.m. after an overnight fast. For gastric motility, the spectral powers (% normal power) and dominant frequency (DF, peak of the power spectrum) of the EGG were evaluated. The CLOCK and PER3 polymorphisms were determined by polymerase chain reaction (PCR) restriction fragment length polymorphism analysis.Subjects with the CLOCK C allele (T/C or C/C genotypes: n = 59) showed a significantly lower DF (mean, 2.56 cpm) than those with the T/T genotype (n = 114, 2.81 cpm, P < 0.05). Subjects with the longer PER3 allele (PER34/5 or PER35/5 genotypes: n = 65) also showed a significantly lower DF (2.55 cpm) than those with the shorter PER34/4 genotype (n = 108, 2.83 cpm, P < 0.05). Furthermore, subjects with both the T/C or C/C and PER34/5 or PER35/5 genotypes showed a significantly lower DF (2.43 cpm, P < 0.05) than subjects with other combinations of the alleles (T/T and PER34/4 genotype, T/C or C/C and PER34/4 genotypes, and T/T and PER34/5 or PER35/5 genotypes).These results suggest that minor polymorphisms of the circadian rhythm genes CLOCK and PER3 may be associated with poor morning gastric motility, and may have a combinatorial effect. The present findings may offer a new viewpoint on the role of circadian rhythm genes on the peripheral circadian systems, including the time-keeping function of the gut.

The essential transactivator function of the HIV Tat protein is regulated by multiple posttranslational modifications. Although individual modifications are well characterized, their crosstalk and dynamics of occurrence during the HIV transcription cycle remain unclear.We examine interactions between two critical modifications within the RNA-binding domain of Tat: monomethylation of lysine 51 (K51) mediated by Set7/9/KMT7, an early event in the Tat transactivation cycle that strengthens the interaction of Tat with TAR RNA, and acetylation of lysine 50 (K50) mediated by p300/KAT3B, a later process that dissociates the complex formed by Tat, TAR RNA and the cyclin T1 subunit of the positive transcription elongation factor b (P-TEFb). We find K51 monomethylation inhibited in synthetic Tat peptides carrying an acetyl group at K50 while acetylation can occur in methylated peptides, albeit at a reduced rate. To examine whether Tat is subject to sequential monomethylation and acetylation in cells, we performed mass spectrometry on immunoprecipitated Tat proteins and generated new modification-specific Tat antibodies against monomethylated/acetylated Tat. No bimodified Tat protein was detected in cells pointing to a demethylation step during the Tat transactivation cycle. We identify lysine-specific demethylase 1 (LSD1/KDM1) as a Tat K51-specific demethylase, which is required for the activation of HIV transcription in latently infected T cells. LSD1/KDM1 and its cofactor CoREST associates with the HIV promoter in vivo and activate Tat transcriptional activity in a K51-dependent manner. In addition, small hairpin RNAs directed against LSD1/KDM1 or inhibition of its activity with the monoamine oxidase inhibitor phenelzine suppresses the activation of HIV transcription in latently infected T cells.Our data support the model that a LSD1/KDM1/CoREST complex, normally known as a transcriptional suppressor, acts as a novel activator of HIV transcription through demethylation of K51 in Tat. Small molecule inhibitors of LSD1/KDM1 show therapeutic promise by enforcing HIV latency in infected T cells.

Objective: Usage of time in range (TIR), measured by continuous glucose monitoring (CGM), has become common as a new index of glycemic control. Therefore, we compared points in range (PIR), measured by the self-monitoring of blood glucose (SMBG), with TIR. Methods: In this prospective observational study, 43 patients with diabetes wore FreeStyle Libre Pro and conducted SMBG at the same time. Time above range (TAR), TIR, time below range (TBR) and points above range (PAR), PIR, points below range (PBR) were compared, respectively. Results: The median PAR was 35.7%, while the median TAR was 20.8% for CGM. Conversely, the PIR was 64.3%, while the TIR was 74.9%; similarly, the PBR was 0%, while the TBR was 1.7%. A significant positive correlation was found between PIR and TIR (r = 0.784, P < 0.001). In the Bland-Altman analysis performed to assess the association between the two methods, PIR showed a -9.9% bias compared with TIR. Conclusions: PIR may be used in patients who find it difficult to use CGM as a substitute of TIR, however caution is needed when interpreting the data due to the difference between PIR and TIR. [ABSTRACT FROM AUTHOR]

Background: Recently in Japan, there have been some cases of pharmacies staffed with dietitians in an effort to improve their health support functions. However, there have been few reports on the effects of these efforts, and it has been pointed out that dietitians may not be fully exercising their professional abilities. We conducted a before-and-after comparison study in 2022 to confirm the effectiveness of collaboration between pharmacy dietitians and pharmacists in supporting patients with type 2 diabetes. Objective: This study aimed to investigate the process by which dietitians who participated in our research project became accustomed to providing continuous dietary counseling as a matter of habit. Methods: Semi-structured interviews were conducted with three dietitians and two pharmacists. The main questions asked were about 1) the nature of their work before they began providing the interventions, 2) the aspects they paid attention to while providing the interventions, 3) what they felt they had changed during the intervention period, and4) what they considered obstacles to providing nutritional guidance in their pharmacies. Results: The responses of the participants regarding the nature of their work before they began providing interventions were mostly related to their "work as a dispensing clerk." The dietitians also indicated their desire for more continuous dietary support. The responses of the participants regarding what they felt had changed during the intervention period included numerous references to having an "opportunity for trial and error" and obtaining the "cooperation of staff." In the responses regarding what the participants considered obstacles, the dietitians mentioned "recognition by patients" and "an environment in which they can consult with patients." Conclusion: This study suggests that "staff cooperation" is essential for dietitians to be able to provide continuous dietary consultation in pharmacies and that all staff must support the creation of an "environment" where dietitians can obtain opportunities for providing continuous dietary counseling. [ABSTRACT FROM AUTHOR]

Objective: We previously reported the mean average relative difference (MARD) of the sensor glucose (SG) of the first-generation FreeStyle Libre with the original algorithm, an intermittent scanning continuous glucose monitoring (isCGM) device, was 15.6% in the Effect of Intermittent-Scanning Continuous Glucose Monitoring to Glycemic Control Including Hypoglycemia and Quality of Life of Patients with Type 1 Diabetes Mellitus Study (ISCHIA Study). In the present study, we aimed to further analyze its accuracy in detail by conducting a post-hoc analysis of the study. Methods: The ISCHIA Study was a multicenter, randomized, cross-over trial to assess the efficacy of isCGM. The SG levels of isCGM and the measured capillary blood glucose (BG) levels of 91 participants were used for the analysis. Results: Bland-Altman analysis showed bias of -13.0 mg/dl when the SG levels were compared to the BG levels, however no proportional bias was observed (r = 0.085). MARD of the participants without and with contact dermatitis were 15.0 ± 6.0% and 27.4 ± 21.4% (P = 0.001), respectively. Conclusion: There was negative bias in the SG levels of isCGM compared to the BG levels. There is a possibility that the complication of the contact dermatitis during isCGM use may be related with deteriorated accuracy of the SG levels. [ABSTRACT FROM AUTHOR]